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Access to palliative care services in hospital: a matter of being in the right hospital. Hospital charts study in a Canadian city.

https://arctichealth.org/en/permalink/ahliterature133654
Source
Palliat Med. 2012 Jan;26(1):89-94
Publication Type
Article
Date
Jan-2012
Author
Joachim Cohen
Donna M Wilson
Amy Thurston
Rod MacLeod
Luc Deliens
Author Affiliation
Ghent University & Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium. jcohen@vub.ac.be
Source
Palliat Med. 2012 Jan;26(1):89-94
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Child
Child, Preschool
Female
Health Services Accessibility - standards
Health Services Research
Hospital Planning
Hospitals, Urban - organization & administration
Humans
Infant
Male
Medical Records
Middle Aged
Palliative Care - organization & administration - standards
Referral and Consultation - standards
Young Adult
Abstract
Access to palliative care (PC) is a major need worldwide. Using hospital charts of all patients who died over one year (April 2008-March 2009) in two mid-sized hospitals of a large Canadian city, similar in size and function and operated by the same administrative group, this study examined which patients who could benefit from PC services actually received these services and which ones did not, and compared their care characteristics. A significantly lower proportion (29%) of patients dying in hospital 2 (without a PC unit and reliant on a visiting PC team) was referred to PC services as compared to in hospital 1 (with a PC unit; 68%). This lower referral likelihood was found for all patient groups, even among cancer patients, and remained after controlling for patient mix. Referral was strongly associated with having cancer and younger age. Referral to PC thus seems to depend, at least in part, on the coincidence of being admitted to the right hospital. This finding suggests that establishing PC units or a team of committed PC providers in every hospital could increase referral rates and equity of access to PC services. The relatively lower access for older and non-cancer patients and technology use in hospital PC services require further attention.
PubMed ID
21680750 View in PubMed
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Advanced palliative home care: next-of-kin's perspective.

https://arctichealth.org/en/permalink/ahliterature18088
Source
J Palliat Med. 2003 Oct;6(5):749-56
Publication Type
Article
Date
Oct-2003
Author
Anna Milberg
Peter Strang
Maria Carlsson
Susanne Börjesson
Author Affiliation
Linköpings Universitet, Division of Geriatrics and Palliative Research Unit, Linköping, Sweden. anna.milberg@lio.se
Source
J Palliat Med. 2003 Oct;6(5):749-56
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Caregivers - psychology
Comparative Study
Family - psychology
Female
Home Care Services - organization & administration
Humans
Male
Palliative Care - organization & administration
Professional-Family Relations
Questionnaires
Reproducibility of Results
Research Support, Non-U.S. Gov't
Sweden
Abstract
GOALS: (1). To describe what aspects are important when next-of-kin evaluate advanced palliative home care (APHC) and (2). to compare the expressed aspects and describe eventual differences among the three settings, which differed in terms of length of services, geographic location, and population size. SUBJECTS AND METHODS: Four to 7 months after the patient's death (87% from cancer), 217 consecutive next-of-kin from three different settings in Sweden responded (response rate 86%) to three open-ended questions via a postal questionnaire. Qualitative content analysis was performed. MAIN RESULTS: Service aspects and comfort emerged as main categories. The staff's competence, attitude and communication, accessibility, and spectrum of services were valued service aspects. Comfort, such as feeling secure, was another important aspect and it concerned the next-of-kin themselves, the patients, and the families. Additionally, comfort was related to interactional issues such as being in the center and sharing caring with the staff. The actual place of care (i.e., being at home) added to the perceived comfort. Of the respondents, 87% described positive aspects of APHC and 28% negative aspects. No major differences were found among the different settings. CONCLUSIONS: Next-of-kin incorporate service aspects and aspects relating to the patient's and family's comfort when evaluating APHC. The importance of these aspects is discussed in relation to the content of palliative care and potential goals.
PubMed ID
14622454 View in PubMed
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Angels of the night: evening and night patrols for homebound elders in Sweden.

https://arctichealth.org/en/permalink/ahliterature71228
Source
Gerontologist. 2003 Oct;43(5):761-5
Publication Type
Article
Date
Oct-2003
Author
Bo Malmberg
Marie Ernsth
Birgitta Larsson
Steven H Zarit
Author Affiliation
Institute of Gerontology, School of Public Health Sciences, Jönköping University, Sweden. bo.malmberg@hhj.hj.se
Source
Gerontologist. 2003 Oct;43(5):761-5
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Female
Health Care Surveys
Home Care Services - organization & administration
Homebound Persons - rehabilitation
Humans
Job Description
Male
Middle Aged
Night Care
Palliative Care - organization & administration
Sweden
Terminal Care - organization & administration
Workload
Abstract
PURPOSE: The purpose of this study was to describe the work of evening and night home care patrols in Swedish old-age care by examining how staff members view their work and the specific work content. DESIGN AND METHODS: The authors developed two questionnaires: one that was to be answered jointly by the patrol teams, and one to be completed by each individual member of a team. All patrols in the municipality of Jönköping, Sweden, were asked to participate. RESULTS: The most frequent kind of help provided by evening and night patrols involves personal care, but help with medications and injections are also frequent. The staff reported that it is becoming more common for the patrols to assist people with terminal illnesses. The patrols also increasingly assist people with psychiatric problems. The staff feels that the job may be becoming too diverse and that they need further education for the range of tasks they are asked to perform. IMPLICATIONS: The patrols are very flexible in the services provided. Without the patrols, the staff members believe that many persons would have to leave their homes to go to institutions.
PubMed ID
14570973 View in PubMed
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An integrative framework for conducting palliative care research with First Nations communities.

https://arctichealth.org/en/permalink/ahliterature144141
Source
J Palliat Care. 2010;26(1):47-53
Publication Type
Article
Date
2010
Author
Holly Prince
Mary Lou Kelley
Author Affiliation
Centre for Education and Research on Aging and Health, and School of Social Work, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, Canada P7B 5E1. hprince@lakeheadu.ca
Source
J Palliat Care. 2010;26(1):47-53
Date
2010
Language
English
Publication Type
Article
Keywords
Community-Based Participatory Research
Community-Institutional Relations
Cultural Competency
Ethics, Research
Health Services, Indigenous - organization & administration
Humans
Indians, North American
Ontario
Palliative Care - organization & administration
Program Development
Notes
Erratum In: J Palliat Care. 2011 Autumn;27(3):preceding 187
PubMed ID
20402186 View in PubMed
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Barriers to and facilitators for implementing quality improvements in palliative care - results from a qualitative interview study in Norway.

https://arctichealth.org/en/permalink/ahliterature279978
Source
BMC Palliat Care. 2016 Jul 15;15:61
Publication Type
Article
Date
Jul-15-2016
Author
Ragni Sommerbakk
Dagny Faksvåg Haugen
Aksel Tjora
Stein Kaasa
Marianne Jensen Hjermstad
Source
BMC Palliat Care. 2016 Jul 15;15:61
Date
Jul-15-2016
Language
English
Publication Type
Article
Keywords
Ambulatory Care Facilities - organization & administration - standards
Attitude of Health Personnel
Clinical Competence - standards
Dementia - nursing
Diffusion of Innovation
Education, Nursing - organization & administration
Health Policy
Health Resources - organization & administration - standards
Healthcare Financing
Hospitalization
Humans
Interprofessional Relations
Leadership
Motivation
Neoplasms - nursing
Norway
Nursing Homes - organization & administration - standards
Organizational Culture
Organizational Policy
Palliative Care - organization & administration - standards
Patient compliance
Professional Role
Qualitative Research
Quality Improvement
Social Responsibility
Abstract
Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway.
Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied.
Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care.
When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important consideration when implementing a symptom assessment tool is whether or not the tool has been validated for the relevant patient group, and to what degree patients need to be involved when using the tool.
PubMed ID
27422410 View in PubMed
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Barriers to providing palliative care in long-term care facilities.

https://arctichealth.org/en/permalink/ahliterature164918
Source
Can Fam Physician. 2006 Apr;52:472-3
Publication Type
Article
Date
Apr-2006
Author
Kevin Brazil
Michel Bédard
Paul Krueger
Alan Taniguchi
Mary Lou Kelley
Carrie McAiney
Christopher Justice
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. brazilk@mcmaster.ca
Source
Can Fam Physician. 2006 Apr;52:472-3
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Clinical Competence - statistics & numerical data
Cross-Sectional Studies
Education, Medical, Continuing - statistics & numerical data
Female
Health Care Surveys
Health Facility Environment - statistics & numerical data
Health Knowledge, Attitudes, Practice
Health Manpower
Humans
Long-Term Care - organization & administration - statistics & numerical data
Male
Ontario
Palliative Care - organization & administration - statistics & numerical data
Physician Executives - statistics & numerical data
Principal Component Analysis
Professional Practice - statistics & numerical data
Residential Facilities - organization & administration - statistics & numerical data
Abstract
To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors.
Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses.
All licensed LTC facilities in Ontario with designated medical directors.
Medical directors in the facilities.
Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received.
Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%).
Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.
Notes
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PubMed ID
17327890 View in PubMed
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The benefits of a palliative care network: a case study in Quebec, Canada.

https://arctichealth.org/en/permalink/ahliterature163165
Source
Int J Palliat Nurs. 2007 Apr;13(4):190-6
Publication Type
Article
Date
Apr-2007
Author
Diane Morin
Louise Saint-Laurent
Marie-Pier Bresse
Clemence Dallaire
Lise Fillion
Author Affiliation
Faculty of Nursing Sciences, Universite Laval, Quebec, Canada. diane.morin@fsi.ulaval.ca
Source
Int J Palliat Nurs. 2007 Apr;13(4):190-6
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Health
Community Networks - organization & administration
Continuity of Patient Care
Cooperative Behavior
Family - psychology
Health Facility Administrators - psychology
Health Services Accessibility
Home Care Services
Humans
Interinstitutional Relations
Interprofessional Relations
Medical Oncology - organization & administration
Medical Staff - psychology
Nursing Evaluation Research
Nursing Methodology Research
Nursing Staff - psychology
Oncology Nursing - organization & administration
Outcome Assessment (Health Care)
Palliative Care - organization & administration
Program Evaluation
Qualitative Research
Quebec
Questionnaires
Abstract
This article aims to present the beneficial effects associated with the local implementation of an integrated network in palliative care, as perceived by diverse constituency groups. A case study was conducted in the province of Quebec, Canada, using individual (n=16) and group (n=16) interviews, with a total of 106 participants (i.e. managers and formal and informal caregivers). From a content analysis, two categories of beneficial effects emerged: those associated with professional practice and those with patient services. The most important effects of this organisational initiative were found to be the recognition of the palliative care domain necessitating specialized competencies, an improved interdisciplinary collaboration, and more efficient circulation of information between care settings, as well as improved accessibility, continuity and quality of care and services to patients at the end of life.
PubMed ID
17551423 View in PubMed
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Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital.

https://arctichealth.org/en/permalink/ahliterature168643
Source
Support Care Cancer. 2006 Oct;14(10):982-7
Publication Type
Article
Date
Oct-2006
Author
Camilla Zimmermann
Dori Seccareccia
Allyson Clarke
David Warr
Gary Rodin
Author Affiliation
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, 610 University Ave., 16th Floor, M5G 2M9, Toronto, ON, Canada. camilla.zimmermann@uhn.on.ca
Source
Support Care Cancer. 2006 Oct;14(10):982-7
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Canada
Community-Institutional Relations
Hospitals
Humans
Interinstitutional Relations
Neoplasms - nursing - therapy
Oncology Service, Hospital - organization & administration
Organizational Objectives
Pain Clinics - organization & administration
Palliative Care - organization & administration
Program Development
Referral and Consultation - organization & administration
Abstract
It is increasingly recognized that complete care of the patient with cancer includes palliative care, which is applicable early in the course of illness, in conjunction with life-prolonging treatment. Princess Margaret Hospital (PMH) is Canada's largest center for cancer care and research, and it is an international referral center for patients with cancer. The Palliative Care Program at PMH has developed into a comprehensive clinical, educational, and research program, with an acute palliative care unit, daily palliative care clinics, a cancer pain clinic, and a consultation service that sees urgent consultations on a same-day basis in inpatient and outpatient areas. We will describe the components, successes, and challenges of our program, which may be useful for others, who are developing palliative care programs in an academic setting.
PubMed ID
16802127 View in PubMed
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155 records – page 1 of 16.